Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System
Pain Assessment and Treatment in Children With Significant Impairment of the Central Nervous System
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DOI：
10.1542/peds.2017-1002
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发表时间：
2017-06-01
期刊：
影响因子：
8
通讯作者：
Houtrow, Amy J.
中科院分区：
文献类型：
--
作者：
Hauer, Julie;Houtrow, Amy J.
对于中枢神经系统受损的儿童来说，疼痛是一个常见且严重的问题，其中受损最严重的儿童发生频率最高且严重程度最高。尽管这个问题很严重，但这一人群仍然容易受到疼痛认识不足和治疗不足的影响。治疗的障碍可能包括识别疼痛的不确定性、经验有限以及对使用疼痛治疗药物的恐惧。本临床报告回顾了行为疼痛评估工具以及干预后监测疼痛的其他策略。该人群的疼痛来源包括由组织损伤或炎症引起的急性疼痛，导致伤害性疼痛，在针对来源进行治疗后，疼痛预计会消退。其他来源也可能导致慢性间歇性疼痛，对许多人来说，这种疼痛每周甚至每天都会发生，通常归因于胃食管反流、痉挛和髋部半脱位。最具挑战性的是中枢神经系统受损引起的疼痛源，需要针对诊断测试无法识别的原因进行经验性药物试验，例如中枢神经性疼痛。审查的干预措施包括综合疗法和药物，例如加巴喷丁类药物、三环类抗抑郁药、α-激动剂和阿片类药物。本临床报告旨在通过基于证据的指导来解决固有的挑战，以提高这一弱势儿童群体一生的舒适度。
Pain is a frequent and significant problem for children with impairment of the central nervous system, with the highest frequency and severity occurring in children with the greatest impairment. Despite the significance of the problem, this population remains vulnerable to underrecognition and undertreatment of pain. Barriers to treatment may include uncertainty in identifying pain along with limited experience and fear with the use of medications for pain treatment. Behavioral pain-assessment tools are reviewed in this clinical report, along with other strategies for monitoring pain after an intervention. Sources of pain in this population include acute-onset pain attributable to tissue injury or inflammation resulting in nociceptive pain, with pain then expected to resolve after treatment directed at the source. Other sources can result in chronic intermittent pain that, for many, occurs on a weekly to daily basis, commonly attributed to gastroesophageal reflux, spasticity, and hip subluxation. Most challenging are pain sources attributable to the impaired central nervous system, requiring empirical medication trials directed at causes that cannot be identified by diagnostic tests, such as central neuropathic pain. Interventions reviewed include integrative therapies and medications, such as gabapentinoids, tricyclic antidepressants, alpha-agonists, and opioids. This clinical report aims to address, with evidence-based guidance, the inherent challenges with the goal to improve comfort throughout life in this vulnerable group of children.